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Effects of specialised nutritional interventions in patients with incurable cancer: a systematic review
  1. Livia Costa de Oliveira,
  2. Larissa Calixto-Lima,
  3. Gabriella da Costa Cunha,
  4. Naira Freire da Silva,
  5. Renata de Souza-Silva,
  6. Tais Saint Martin Fonseca,
  7. Thamiris de Souza,
  8. Carolline de Melo Santos,
  9. Daiane Almeida dos Santos and
  10. Emanuelly Varea Maria Wiegert
  1. Palliative Care Unit, National Cancer Institute, Rio de Janeiro, Brazil
  1. Correspondence to Dr Livia Costa de Oliveira, Palliative Care Unit, National Cancer Institute, Rio de Janeiro, RJ, Brazil; lillycostaoliveira{at}


Objective To evaluate current evidence of the effect of specialised nutritional interventions on nutritional status, survival, quality of life and measures of functionality in patients with incurable cancer.

Methods Systematic literature review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using PubMed/MEDLINE, EMBASE, Scopus, LILACS and Cochrane Library databases. Clinical studies that evaluated different specialised nutritional interventions, such as nutritional counselling, oral nutritional supplementation (ONS), enteral nutrition (EN) and parenteral nutrition (PN), were eligible. Only studies classified as being of high methodological quality (ie, low or moderate risk of bias) were included.

Results A total of 22 studies reporting on 2448 patients were deemed eligible. Five types of specialised nutrition were observed: mixed (multimodal nature, ie, dietary counseling, ONS, physical activity and/or drugs) (n=12), ONS (n=5), PN (n=3), EN (n=1) and multidisciplinary team counselling (n=1). Benefits of any kind from the interventions were reported in 14 (63.6%) studies, mainly resulting from mixed intervention. Nutritional status improved in 12 (60.0%) of 20 studies and quality of life improved in eight (50.0%) of 16 studies. Few studies have evaluated the influence of nutritional interventions on survival and measure of functionality, and have not shown improvement in these outcomes.

Conclusion Despite the limited evidence, specialised nutritional interventions can yield positive effects for patients with incurable cancer, mainly in their nutritional status and quality of life.

  • cancer
  • clinical decisions
  • complementary therapy
  • quality of life
  • supportive care
  • rehabilitation

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  • Contributors LCdO, LC-L and EVMW contributed to study design. LCdO, LC-L EVMW, GdCC, NFdS, RdS-S and TdS designed the protocol. GdCC, TdS and EVMW conducted the database searches. RS-S and TdS performed the screening and quality assessment. GdCC, NFdS, TSMF and DAdS performed the data extraction and analyzed the data. GdCC, NFdS, RS-S, TdS, TSMF, DAdS and CdMS performed the analysis of the results. LCdO, LC-L and EVMW reviewed the paper and had overall responsibility for the final content. All the authors contributed to the synthesis and have approved the paper. LCdO is the author acting as guarantor and is the corresponding author.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.